In neonates, how effective is lung ultrasonography in directing chest physiotherapy intervention when compared to chest x-ray and auscultation?

Bronagh McAlinden, Michael Steele, Judith Hough, Matthew Gouveia
Purpose:

The primary objective was to evaluate the impact of LUS compared to current chest physiotherapy outcome measures on clinical decision-making in the NICU.

Methods:

The study was a single-centre prospective observational study at the Mater Mothers Hospital, Brisbane NICU.

Included infants admitted to the Mater Mothers Hospital NICU during the two-week study period were mechanically ventilated and had a chest x-ray (CXR) within the preceding 24 hours. They were excluded if LUS was not possible, were expected to discharge or back transfer in less than 24 hours or had a plan for redirection of care.

Participants were assessed using CXR and auscultation by a physiotherapist, who recorded a diagnosis and intervention plan. An examiner blinded to the initial assessment performed LUS. After receiving the LUS results, the initial therapist recorded a re-evaluated intervention plan. 

The primary outcome was net reclassification improvement (NRI), which quantified how frequently LUS reclassified diagnosis and treatment. Secondary outcomes included diagnostic concordance and confidence in diagnoses. 

Results:

From the 11 participants included, diagnosis and treatment was modified following an LUS assessment in 9.1% (NRI=9.1%, p=0.041) of cases. Furthermore, this was found to be statistically significant. Diagnostic discordance was observed in 73% (n=8) of cases and treatment was altered in two. Confidence in diagnosis increased by 0.6/7 points (p=0.008) after LUS across the study.

Conclusion(s):

A statistically significant NRI and a high degree of diagnostic discordance indicates that LUS may be beneficial to decision-making in the NICU. Future research should consider larger sample sizes to aid in substantiating the relationships found, investigate the level of clinical significance for the NRI and, consider other variables impacting LUS’s clinical effectiveness.

Implications:

This study urges future research on LUS's impact on CPT decision-making in the NICU. These results are promising considering the importance of accurate diagnoses in a fragile neonatal cohort. More highly powered studies are required to add to this literature and allow for clinical application.



Funding acknowledgements:
Unfunded
Keywords:
Neonatal Intensive Care Unit
Chest Physiotherapy
Lung Ultrasound
Primary topic:
Cardiorespiratory
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Mater Mothers Hospital, Brisbane Australian Catholic University, Brisbane
Provide the ethics approval number:
Mater: Project 103799; ACU: 2024-3331R
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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